Population Health Flashcards
What is health?
WHO: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Multidimensional latent construct (cannot be directly observed), important when trying to measure it
How can health be measured?
Life expectancy, Self-rated health, CES-D, Disability-Adjusted-Life-Years, Corona infection rate, # of days in hospital, etc.
How can health be viewed in a dynamic process?
The process of population health change:
- Risk factors: biological markers (e.g. cholesterol, weight) of underlying health and one’s propensity to disease, generally preceding the onset of related diseases (e.g. CVD, diabetes)
- Functioning loss: inability to perform certain physical or mental tasks, generally resulting from onset of diseases or conditions and occurring at a later age than disease onset
- Disability: performance of expected social roles not possible anymore => potential influence of external environment (!)
–> changes in these individual-level processes sometimes combine in complex ways to generate changes in population health
What does the ETT describe?
Epidemiologic Transition Theory
the process by which the pattern of mortality and disease in a population is transformed from high mortality among infants and children but also famine and epidemics affecting all age groups to a mortality pattern of degenerative and human-made diseases (such as those attributed to smoking) affecting principally the elderly.
-> pandemics of infection are gradually displaced by degenerative and man-made [sic] diseases as the chief form of morbidity and primary cause of death
What are the different phases of the ETT?
(1) Age of Pestilence & Famine (CVD*: 5-10%)
- Pre-history times with high and fluctuating mortality rates, low average life span –> periods of population growth are not sustained
- characterized by: dietary deficiencies (less diverse), inadequate food storage, increased transmission rates and endemic disease (population density), high potential for disease spread (global trade)
(2) Age of Receding Pandemics (CVD: 10-35%)
- Early modern period
- Declining mortality rates (epidemics less frequent), an increase in average life expectancy from about 30 to 50 years –> population growth that eventually becomes exponential
- Shift in disease/mortality from primarily infectious diseases to what have come to be called “chronic” diseases (i.e. cancer, diabetes, heart diseases, etc)
(3) Age of Degenerative & Man-Made Diseases (CVD: 35>50%)
- Late 19th and 20th centuries in developed countries
- Infectious disease pandemics are replaced as major causes of death by degenerative diseases
- With declines in mortality rates, average life expectancy increases to > 50 years
(4) Age of Delayed Degenerative Diseases (CVD: <50%)
- Highly developed countries with great medical systems
- Chronic disease are not fatal anymore, people with diabetes can live long lifes
(5) e.g.: Age of Obesity & Inactivity (Addition of Gaziano, 2010)
Explanations for ETT?
3 major categories involve (by far not exhaustive):
1) Ecobiologic determinants of mortality (i.e. recession of plague - not fully understood why)
2) Socioeconomic, political (less wars) and cultural determinants include standards of living, health habits and hygiene and nutrition (in western countries rather a byproduct of social change than a result of medical design)
3) Medical and public health determinants (i.e. Antibiotics)
It is generally believed that epidemiologic transitions prior to the 20th century (i.e., those that took place in today’s industrialized countries) were closely associated with rising standards of living, nutrition, and sanitation.
In contrast, those occurring in developing countries beginning in the 20th century have been more or less independent of such internal socioeconomic development and more closely tied to organized health care and disease control programs developed and financed internationally.
Relation between socio-economic development & population health?
1) Preston-Curve
Preston (1975): upward shift of the curve that links GDP per person on the horizontal axis and life expectancy on the vertical
-> interpreted this shift as the effect of medical progress and health care above the effect of income
Interesting outliers that should have higher life expect. but spec. circumstances:
1) Russia - Dissolution of USSR
2) South Africa - HIV/AIDS
–> BUT it still matters how countries spend money (curative vs preventive)
Relation between socio-economic development & population health?
2) Child mortality
- huge difference between high & low-income countries regarding child mortality (ca. 30%)
- Little money makes huge impact in population health (knowledge), especially in child mortality as top causes (pneumonia, diarrhea & malaria) can be easily avoided
Relation between socio-economic development & population health (adult & children)
3) Within-country differences (example:USA)
Positive relationship between income and health -> low-income people live shorter lives than high-income people in a given country:
Americans in the bottom 5 % of the income distribution in 1980 had a life-expectancy at all ages that was about 25 % lower than the corresponding life-expectancies of those in the top 5 % of the income distribution
+ also, child mortality within countries varies immensely
-> reducing economic gap within country can immensely impact (child) mortality
Importance of health behaviors (i.e. smoking)
Beyond medical advance, the major factor in reduced cardiovascular disease mortality is the reduction in smoking. Smoking rates in the United States have fallen to half their level at the time of the Surgeon General’s 1964 report on the harms of smoking. Continued public health campaigns against tobacco use have been an important part of this decline
How has child mortality developed?
Massive decline: Child mortality halved from 43% in 1800 to 22.5% in 1950 and then to 4.5% in 2015 …
-> large share of continued infant mortality reductions to improved neonatal medical care for low birth-weight infants
How will child health look in the future?
Recent research for the UK (Ward et al. 2021) forecasts …
- further falls in causes that have historically dominated disease in children and young people, such as infectious diseases, cancers and injuries,
- but increases in mental health problems (more awareness), other adolescent health issues and the consequences of neonatal survival, such as neuro-disability and epilepsy (should’ve died at birth, now as children)
Childhood health = Adult Health?
Childhood is a life-stage characterized by particular vulnerabilities causing immediate health risks, but it also is a sensitive, critical period for individuals’ health across the life-course (e.g., Kuh 2003):
1) latency model (childhood health adult health) –> direct effect of child health to adult health
2) pathway model (childhood health SES adult health) –> indirect effect: bc you were sick, u will be less capable to achieve socioeconomic position/not perform as well which will then effect ur adult health
-> Hank (2012) study: long arm of childhood health, even 50 years later independent effect on adult health:
“We conclude that unfavorable childhood conditions exhibit a harmful influence on individuals’ chances to age well across all European welfare states considered in this study“
What is “Successful Aging”?
Definition according to Rowe & Kahn (1997):
- “[A]voidance of disease and disability
- maintenance of high physical and cognitive function and
- sustained engagement in social and productive activities.”
–> Authors strive to identify protective factors, to develop intervention strategies promoting quality of life in old age & to encourage people to make lifestyle choices that improve their likelihood of aging well
How many are aging successfully?
Overall trend: proportion of men/woman who survive age 65 increased substantially in EU and other western countries + age span from 65 onwards is also increasing (from 15 to 20/25 years)
BUT data varies enormously from country to country, 10% in Germany are aging successfully, 20% in Sweden, 2% in Poland
-> differences in conditions under which older/aging people live?
Changes in the Global Burden of Disease since 1990
2) Depression
- Nearly 300 million people are estimated to suffer from depression worldwide making it the single largest factor contributing to disability (by 2030)
- Major depressive disorders are also associated with increased CVD and mortality risks (including suicide)
- In the period 1990-2017 (!), the number of incident cases of depression increased by almost 50%, from 17.2 to 25.8 million
(Why? Physical burden < psychological burden?)
The proportions of the population with major depressive disorders remained essentially stable (both globally and in various countries).
Why can growing numbers of HIV or Covid-19 also be positively interpreted?
Because mortality rates are declining (i.e. medication/vaccination) which subsequently means people can live longer with HIV
Health disparities for sexual minorities?
YES even increased health disparities between straight/not straight nowadays, bisexuals greatest health disparity
Why?
- Different reasons why there might be differences: lack of gender/relationship recognition, poverty, lack of data, discrimination, stress (seems to be main reason –> even tho minority stress may have declined, societies have become more liberal, but they suffer more from remaining stigma)
- Also, older cohorts not as open
